2004 2005 Magnetom Flash 2 2

MAGNETOM
Issue no. 2 · 2004

RSNA Edition
www.siemens.com/magnetom-world
FLASH
Price 10,- EUR
Content
MAGNETOM Espree
First Installation
Page 6
MR Cholangiography
with iPAT and PACE
Page 56
Upgrade MAGNETOM Vision

to MAGNETOM Symphony
Page 60
MAGNETOM Avanto
Case Reports
CONTENT
4 EDITORIAL
64 IMPRESSUM
PRODUCT NEWS
6 Monday, September 20, 2004
The World’s First Open Bore, High-Field MRI Installed
10 MAGNETOM C! …
…is Changing the Face of Mid-Field MRI
CLINICAL
16 Case Report:
MRCP and MR of the Liver (Pre- and Post-Contrast Examinations)
19 Case Report:
Prenatal Diagnosis of Diaphragmatic Hernia
22 Case Report:
MRI of the Thorax
26 Case Report:
Whole Body MRI
36 Case Report:
MRI of the Lower Extremities
38 Case Report:
MR-Urography
40 Case Report:
Pediatric MRI of the Hepatobiliary System
42 Case Report:
Whole Body MRA
2 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

CONTENT
TECHNOLOGY
46 All You Want to Know about FatSat
52 MRI Procedures and Transdermal Medication Patches
54 Fast and Ultrafast MR-Sialography
58 Clinical Results with T2_tse_rst_3d_pace_ipat Pulse Sequence
LIFE
60 Upgrade MAGNETOM Vision to MAGNETOM Symphony
62 Welcome to Singapore
The information presented in MAGNETOM Flash is for illustration only and is not
intended to be relied upon by the reader for instruction as to the practice of medicine.
Any health care practitioner reading this information is reminded that they must use
their own learning, training and expertise in dealing with their individual patients.
This material does not substitute for that duty and is not intended by Siemens Medical
Solutions to be used for any purpose in that regard.
The drugs and doses mentioned in MAGNETOM Flash are consistent with the approval
labeling for uses and/or indications of the drug. The treating physician bears the sole
responsibility for the diagnosis and treatment of patients, including drugs and doses
prescribed in connection with such use. The Operating Instructions must always be
strictly followed when operating the MR System. The source for the technical data is
the corresponding data sheets.
MAGNETOM FLASH 2/2004 3

EDITORIAL
Farewell to all MAGNETOM

Flash readers
For the last four years I have had moving around the US from July to
the privilege and pleasure of working October.
with the MR Division in Erlangen. The roadshow idea came about
Even though my specific assignments from the need to introduce our latest
were related to the US MR group, Tim product in the US without the
on many occasions I have had the advantage of a major trade show or
opportunity to work with others other major event in which to show
from around the world. One of these the product. The MAGNETOM Espree
tasks was to assist the Editor of the is situated in a mobile showroom
MAGNETOM Flash with reviewing that is taken from destination to
and editing articles for the periodical. destination including cities like New
I will no longer be able to participate York, Cleveland, Omaha, Seattle,
in this function with my new assign- Las Vegas, Dallas and many others,
ment back within the US MR group in where it is set up for customer events
Malvern PA. I enjoyed working with as well as local sales reps’ training.
the Flash very much since I know The total of sixteen roadshows will
how important the magazine is to end in Orlando to time with our
our readers around the world. National Sales Meeting.
I have met many of our users Overall the roadshow has been
during the last four years and several very successful. We are confident
most recently at the MAGNETOM that the Open Bore MAGNETOM
Summit meeting held in the beautiful Espree will have a perfect fit in the
Bavarian resort on the Tegernsee. US Market and this is strengthened
There we listened to speakers and by the reactions of customer who
customers from around the world have seen the system.
able and willing to share ideas and In closing I want to add my best
experiences with their MAGNETOM regards to my Erlangen colleagues.
MR Systems. Experiences that ranged I miss them very much. My past four
from early experiences with the years in Germany were an experience
MAGNETOM Avanto all the way to of a lifetime. It was as difficult to
the futuristic views of Dr. Larry Wald leave Germany as it was to leave my Editorial Team
and potential continuing develop- family and friends in the US when
ments through the RF technology. I first moved to Germany. But, I look
The meeting was not all work: forward to continuing my contact
there was time to enjoy local food with as many of you as possible.
and fun in the Bavarian Alps high There will be many opportunities for
above the Tegernsee. It was truly a our paths to cross in the future.
memorable event (did I really see
people sniffing tobacco powder Enjoy this issue of Flash.
and then blow their nose in colored
Editor’s note:
bandanas???) and I will always
We miss you a lot
remember this World Summit as I
too Charlie…
hope will all of you.
I hope to see you
Regarding my current status.
and your family
I left the MR Marketing in Erlangen
in Arkansas in
and returned to the US as of the first
the near future.
of September 2004, and since my
Good luck!
return, I have hit the road running.
I am very involved in the US product Charlie Collins, B.S.R.T.
launch for the MAGNETOM Espree. Market Manager (USA),
The launch is actually a “roadshow” Erlangen

EDITORIAL
Charlie Collins
in Malvern, PA,
USA
Marion Hellinger, MTRA Lisa Reid, Dagmar Thomsik- Antje Hellwich A. Nejat Bengi, M.D.
MR Marketing- US Installed Base Schröpfer, Ph.D. Associate Editor Editor in Chief
Application Training, Manager, MR Marketing-Products,
Erlangen Malvern, PA Erlangen
Achim Riedl Milind Dhamankar, M.D. Tony Enright, Ph.D. Peter Kreisler, Ph.D. Stuart Schmeets Gary R. McNeal, MS (BME)
Technical Support, Manager Clinical MR Asia Pacific Collaborations & Advanced 3T Advanced Application Specialist
Erlangen Research Collaborations, Collaborations, Applications, Erlangen Applications Specialist Cardiovascular MR Imaging
Siemens Medical Australia Siemens Medical Solutions USA
Solutions USA
We thank Mr. Lowrence Tallentire for this editorial help.

PRODUCT NEWS
MAGNETOM ESPREE
The World’s First Open Bore, High-Field

MRI Installed
Antje Hellwich Monday, September 20, 2004 Combining what patients
MAGNETOM Espree – want with the features radiol-
Siemens AG The world’s first Open Bore, ogists need.
Medical Solutions, 1.5 Tesla MRI installed at
Magnetic Resonance Division, MAGNETOM Espree offers, for the
Mayo Clinic, Jacksonville,
Customer Care Manager, first time, CT-like comfort with its
Florida, USA.
Erlangen, Germany 70 cm patient bore and its short and
Mayo Clinic is a multi-specialty open magnet. So it’s head-out and
medical clinic in Jacksonville, Florida. feet first for most exams. Perfect for
The staff includes 328 physicians obese and claustrophobic patients.
who provide diagnosis, treatment To make the examination quick
and surgery working in more than and comfortable for the patient,
40 specialties. Patients who need MAGNETOM Espree – a Tim system –
hospitalization are admitted to combines up to 76 seamlessly inte-
nearby St. Luke’s Hospital, a 289-bed grated matrix coil elements and up
Mayo facility. to 18 RF channels to create one Total
imaging matrix. This means only one
70 cm + 125 cm + 1.5T + Tim set-up of coils, no patient reposition-
ing and no coil repositioning.
At Siemens Medical Solutions When scanning large anatomical
in Erlangen, Germany the challenge areas with the seamlessly integrated
was not to make a more “open” Matrix coils you will get highest
Open, but to retain the performance signal to noise and local coil image
of a 1.5T system in combination with quality without restriction in cover-
the most open design possible. This age.
combination of 1.5T, Open Bore, and
Tim, the Total imaging matrix, is
something only Siemens could do as
Siemens is the only vendor designing
and integrating magnets, gradients
and RF-coils in-house.
At Mayo Clinic, Jacksonville, USA
the challenge was not to decide for
a patient friendly system with a very
wide 70 cm bore, a very short 125
cm magnet and the powerful per-
formance of 1.5T with Tim. The
challenge was to find a day without
hurricane warning to install the
MAGNETOM Espree.

PRODUCT NEWS
MAGNETOM ESPREE
“This is going to increase our efficiency and patient convenience,” says increasing worldwide. Every fifth
Dr. Jerald Pietan, chair of Mayo’s Department of Radiology. “The patient-friendly adult is considered obese in the UK
design of this magnet will make it easier for large patients and those with and the rate is even higher in the US.
claustrophobia to have an MRI examination which produces quality images. This results for the United States
This can reduce the need to repeat and interrupt exams.” alone in 44 million patients who have
only limited access to high-field MR
so far, but a high risk for cardiovas-
cular diseases and orthopedic distor-
tions. Currently, patients too large
to fit inside the bore of a high-field
MRI magnet have image studies done
in open MRI-systems with low-field
magnets. Now MAGNETOM Espree
features almost one foot (30 cm) of
free space between a patient’s head
and the magnet. With the shortest
1.5 Tesla magnet now available more
than 60% of exams can be completed
with the patient’s head outside the
bore, helping to ease claustrophobia.
On the technical side MAGNETOM
Espree is available with Tim [32 x 8]
At Mayo Clinic creativity in using

the new dimensions in MR has gone
sky high. Their MAGNETOM Espree is
used for routine orthopedic imaging
e.g. wrist imaging: here the face down
Superman position so far used for
wrist imaging might be superseded
by the patient sitting comfortably at
the end of the magnet with his/her
arm extended horizontally into the
magnet.
Or for long bones and entire
extremity scanning: Without
MAGNETOM Espree the technologists
would scan thighs then calves or
upper then lower arms and these
would be read as separate series. Wrist images.
With their new seamless anatomical
coverage these separate scans are
a thing of the past. The same is true
for spine imaging.
But leaving aside their creativity,
the mere patient friendliness of its
new system could gain Mayo Clinic
up to 400 additional referrals a year
from orthopedic surgeons if claustro-
phobic concerns are alleviated. Not
to mention obese patients. Obesity is Whole spine image.

PRODUCT NEWS
MAGNETOM ESPREE
Carotid MRA with coverage from

aortic arch to circle of Willis.
MAGNETOM Espree –
Revolutionary workflow
Surrounding MAGNETOM Espree
are a whole group of innovations
that will not only change the way you
work. But are surprisingly easy to work
with. Of course, you have already
met Tim and know that it will help to
accelerate patient setup, scan times
and exams. But there is more.
• Inline Technology enables real-

time processing. Eliminating many
manual steps. Get immediate clinical
results for prospective motion
Cervical spine images correction (PACE), diffusion, perfu-
with coverage from C1 sion, and MRI angiograms.
to T4. • Phoenix, unique to Siemens,
gives you superior reproducibility
based on a one-click drag & drop
of images, not on protocols.
or with Tim [76 x 18]. And it comes resolution images without sacrificing • Another innovation for MRI work-
with a Z-engine (33 mT/m, SR 100 signal-to-noise. Tim ensures higher flow is AutoAlign™ which enables
T/m/s) gradient system. SNR, enabling best image quality automatic slice positioning.
Tim is the ideal solution for even with highest PAT factor. For Delivering highest reproducibility
MAGNETOM Espree. Its Matrix coils studies ranging from clinical routine with uniform consistent results,
can be combined seamlessly to up to advanced applications such as even with new staff.
achieve large coverage and high- tumor staging. • And, helping to make it easier than
ever to get patients ready for exams
is Intelligent Coil Control. With
Automatic Coil Position Detection
of all coil elements both fixed and
flexible, you’re just a click away
from faster exam set-up with little
interaction.
The second MAGNETOM Espree

is up and running at the Turville Bay
MRI Centers in Madison, Wisconsin,
USA.
CSI spectroscopy. Whole body imaging with
MAGNETOM Espree.

PRODUCT NEWS
MAGNETOM ESPREE
MAGNETOM Espree

PRODUCT NEWS
MAGNETOM C!
MAGNETOM C! …
…is Changing the Face of Mid-Field MRI
Stefan Domalski The MAGNETOM C! is an open In Europe, the first MAGNETOM C!
MRI system based on over 25 years of was installed on September 4 at the
Siemens AG Siemens MR experience, following Eduardus Hospital in Cologne,
Medical Solutions, the tradition of spearheading the Germany, while the first US system
Magnetic Resonance Division, innovations in open MRI. A high-field went to the Physicians Imaging
Market Segment Manager Open gradient system with 24 mT/m and Center in Dallas, Texas.
Systems, Erlangen, Germany a true multi-channel RF system with This before meeting the public
up to four channels and coils able to at the “Open MRI in Clinical Practice”
cover up to 100 cm (25”) field of view meeting in Las Vegas, Nevada, side
are built into the most compact by side with the MAGNETOM Espree.
MAGNETOM World Events magnet in mid-field, reducing claus- The MAGNETOM C! has been
around the globe trophobia to the minimum. The developed and is manufactured at
system is equipped with iPAT parallel the new Siemens MR facility in
On July 19, 2004 a new member of acquisition techniques and multi- Shenzhen, China – evidence of the
the MAGNETOM family achieved US directional motion correction 2D Siemens philosophy of being close
market clearance – MAGNETOM C! – PACE for fast and robust examina- to customers anywhere in the world.
the first open MAGNETOM operating tions. In addition to research, development
at 0.35T. It is also a member of the The MAGNETOM C! was intro- and manufacturing, a Headquarter
MAGNETOM Open family together duced to the MR community during Support Center (HSC) for MR will be
with the 0.2T MAGNETOM Concerto a global series of MAGNETOM World set up in Shenzhen, complementing
and the 1.5T MAGNETOM Espree. events that began in July at the the two existing centers in Erlangen,
Caravelle Hotel in Ho-Chi-Minh City, Germany and Cary, North Carolina,
Vietnam, where 86 MR experts from USA with a center in the Asian time
all over Asia were the first to see the zone. The center in Shenzhen
new system and its potential. has started operations and supports
The first MAGNETOM C! in Asia not only the MAGNETOM C! but
was installed at the Airforce General also all other MAGNETOM systems.
Hospital in Beijing, China in June
2004. Following the first clinical
studies, 150 guests were invited to
its official inauguration at the
Shangri-La hotel in Beijing, at which
Prof. Zhang Wanshi shared his initial
experiences of working with the
new system. MR users from all over
the world have taken the opportunity
to check out the MAGNETOM C! in
Beijing in the first couple of months
after installation and appreciated
the exceptional image quality and
The first MAGNETOM C! installed easy handling of the system.
in Europe being delivered to The HOSPEQ exhibition at the Beijing
the Eduardus Hospital in Cologne, exhibition center was the first
Germany. trade show world-wide featuring
the MAGNETOM C!

PRODUCT NEWS
MAGNETOM C!
The MAGNETOM C! was introduced to the customers in

USA with a presentation at the Open MRI in Clinical
Practice Meeting and a reception at the Hard Rock Hotel.
MAGNETOM C! appearing from a cloud of mist and lights

at the inauguration event at the Shangri-La Hotel,
Beijing, China on Aug 7, 2004.
Delegates at the MAGNETOM C! inauguration meeting on June 12, Prof. Zhang Wanshi from Airforce
2004 at the Caravelle Hotel in Ho-Chi-Minh City, Vietnam. General Hospital in Beijing, China
in front of his new MAGNETOM C!,
the first system in the world was
installed in June 2004.

PRODUCT NEWS
MAGNETOM C!
T2 TSE Restore, 3 steps, 512 matrix, T2 TSE Restore, 512 matrix, 280 mm FoV, SL 3.0 mm.
345 mm FoV, SL 4.0 mm.
3D MIP, FLASH 2D, 512 matrix,

221 mm FoV, SL 78 mm.
TIRM Dark Fluid, 512 matrix, 239 mm FoV, SL 5.0 mm.

PRODUCT NEWS
MAGNETOM C!
MAGNETOM C!
Image Gallery
3D CISS, 512 matrix, 216 mm FoV, TrueFISP 2D, 256 matrix, 263 mm FLASH 2D, 512 matrix, 363 mm FoV,
SL 3.0 mm. FoV, SL 8.0 mm. SL 6.0 mm.
FLASH 3D we, 384 matrix, 146 mm TSE Restore, 640 matrix, 250 mm
FoV, SL 3.5 mm. FoV, SL 4.0 mm.
3D DESS, 512 matrix, 115 mm FoV, TSE Restore, PAT x 2, 512 matrix, FLASH 2D we, 256 matrix, 160 mm FoV,
SL 2.0 mm. 180 mm FoV, SL 4.0 mm. Courtesy of Eduardus Hospital, Cologne,
Germany.

PRODUCT NEWS
MAGNETOM C!
TSE Restore, 512 matrix, 300 mm FLASH 2D we, 256 matrix,

FoV, SL 4.0 mm, Courtesy of Prof. 160 mm FoV, SL 4.0 mm,
Zhang Wanshi, Airforce General Courtesy of Eduardus Hospital,
Hospital, Beijing, P.R. China. Cologne, Germany.
3D MRCP with 2D PACE multi direc- Cine FLASH 2D with tagging,

tional motion correction algorithm, Courtesy of Prof. Zhang
Courtesy of Hai Nan Nong Ken Sanya Wanshi, Airforce General
Hospital, P.R. China. Hospital, Beijing, P.R. China.
3D MIP, FLASH 2D, Hui Yang No. 1

People’s Hospital, Hui Yang, P.R. China.

PRODUCT NEWS
MAGNETOM C!
MAGNETOM C!
Image Gallery
FLASH 2D, 512 matrix, Triple contrast TSE, 512 matrix,

350 mm FoV, SL 8.0 mm, 350 mm FoV, SL 10.0 mm,
Courtesy of Hui Yang No. 1 People’s Courtesy of Hui Yang No. 1 People’s
Hospital, Hui Yang, P.R. China. Hospital, Hui Yang, P.R. China.
3D HASTE, 192 matrix, TSE Restore with PAT x 2, 256 matrix, 3D MIP of 3D HASTE, 192 matrix,
250 mm FoV, SL 8.0 mm, 260 mm FoV, SL 4.0 mm in 2:11 min. 250 mm FoV, SL 45 mm.
Courtesy of Hui Yang No. 1 People’s
Hospital, Hui Yang, P.R. China.

CLINICAL
MRCP
Case Report: MRCP and MR of the Liver

(Pre- and Post-Contrast Examinations)
Michael Fenchel, M.D. Examination Findings
Ulrich Kramer, M.D.
Katrin Tomaschko Examination was performed on a 1. Klatskin tumor (size 4.2 x 3.0 cm)
Heinz-Peter Schlemmer, M.D. 1.5T Siemens MAGNETOM Avanto with potential infiltration of the
scanner using a Body Matrix coil. portal venous system in the right
University Hospital Tübingen, 20 minutes before starting the lobe of the liver.
Dept. of Radiology examination, 300 ml of Lumirem
Tübingen, Germany (iron-oxide) were administered p.o. 2. Occlusion of the right portal
to reduce intraluminal signal from venous branch in the region of
duodenum. Immediately before the the tumor.
Patient History MRCP (MR Cholangiopancreatogra-
phie) examination, 40 mg of butyl- 3. Infiltration of right and left
47 year old male patient with known scopolamide (Buscopan, Boehringer, hepatic arteries without affecting
Klatskin tumor (stage III). Germany) were administered intra- the bile ducts in this area.
MR images were performed venously to suppress bowel peristal-
to assess the vascular status of the sis. 4. Intrahepatic cholestasis particularly
abdomen and to rule out a Images depicting the abdominal in the right lobe of the liver.
pyelothrombosis. anatomy were acquired using a
coronal HASTE, an axial navigator
triggered fat suppressed T2-weighted
TSE sequence and a T1-weighted
breath-hold FLASH 2D sequence.
MRCP was performed using a
coronal, heavily T2-weighted TSE 3D
sequence with PACE enabling free
breathing of the patient during the
examination. MR images were post-
processed subsequently using a
maximum intensity projection (MIP)
algorithm.
2 ml Gadolinium-DTPA were
injected as test bolus to measure the
circulation time. A coronal angulated
FLASH 3D sequence in breath-hold
technique was used to acquire pre
and post contrast images. The scan
delay was calculated according to the
following formula: circulation time –
time to center of k-space + 4 [s].
Contrast agent dose was 0.15
mmol Gd-DTPA/ kg body weight.
Two sets of post contrast data were
acquired. Furthermore, axial fat
suppressed FLASH 2D post contrast
images were recorded.

CLINICAL
MRCP
FLASH 3D FLASH 3D FLASH 3D
FLASH 3D FLASH 3D T2_TSE_fs
FLASH 2D_fs FLASH 2D_fs FLASH 2D_fs

CLINICAL
MRCP
MRA arterial phase. MRA portal venous phase.
MRCP MIP image, TSE 3D. MRCP MIP image, TSE 3D.

CLINICAL
PRENATAL
Case Report:
Prenatal Diagnosis of Diaphragmatic Hernia
Ulrich Kramer, M.D. Examination Findings
Michael Fenchel, M.D.
Katrin Tomaschko Examination was performed on a The fetus presented with pelvic
Heinz-Peter Schlemmer, M.D. 1.5T Siemens MAGNETOM Avanto orientation, the placenta was situated
scanner using two Body Matrix coils. ventrally. Situs inversus presenting
University Hospital Tübingen, Mother’s position was oblique to with a left sided liver was detected.
Dept. of Radiology the left side to reduce compression Mesenterial structures were detected
Tübingen, Germany of the inferior vena cava by the fetus in the dorsal mediastinum predomi-
leading to reduced venous flow to nantly on the left side. The volume
the right atrium. In order to reduce of the left lung was considerably
Patient History artifacts due to movement of the reduced secondary to compression
fetus, sedation was accomplished by by intestinal structures. Urogenital
Fetus in the 26th week of gestation oral administration of 5 mg diazepam structures and urinary bladder
(36 year old mother) with history prior to the examination. appeared normal.
of known situs inversus and sono- First, localizer images were
graphic suspicion of atrial septum acquired to find the correct angula-
defect and diaphragmal hernia. MR tion for coronal and sagittal slices in Discussion
imaging was requested to confirm the fetus. Subsequently, TrueFISP High resolution fetal MRI could easily
the suspicion of diaphragmal hernia sequences were used to get anatomi- be performed in a case with situs
for planning surgery. cal coverage of thoracic and abdomi- inversus demonstrating a large
nal structures of the fetus. Represen- diaphragmal defect with left sided
tative angulations were repeated dystopia of abdominal structures in
with T2-weighted TSE sequences to the mediastinum and consecutive
demonstrate the findings with lung compression. This crucial infor-
increased resolution. mation was needed for further
therapy planning because surgery
is indispensable in this case to keep
Sequences the baby alive after delivery.
HASTE (sagittal):
FoV: 217 x 290 mm,
slice thickness: 4 mm,
matrix: 328 x 512 mm,
flip angle: 150°, TR: 1310 ms,
TE: 74 ms, BW: 630 Hz/Px
TrueFISP (coronal and sagittal):

FoV: 325 x 400 mm,
flip angle: 69°, TR: 4.3 ms,
TE: 2.0 ms, BW: 490 Hz/Px.
T2w TSE (sagittal):

FoV: 218 x 290 mm,
flip angle: 150°, TR: 3940 ms,
TE: 103 ms, BW: 260 Hz/Px,
ETL = 23, Av = 3
The safety of imaging (fetuses, infants)

has not been established.

CLINICAL
PRENATAL
TrueFISP TrueFISP
TrueFISP


CLINICAL
PRENATAL
TrueFISP TrueFISP TrueFISP
TrueFISP HASTE


CLINICAL
THORAX
Case Report:
MRI of the Thorax
Michael Fenchel, M.D. Examination Findings
Ulrich Kramer, M.D.
Katrin Tomaschko Examination was performed on Multiple pulmonary lung nodes were
Heinz-Peter Schlemmer, M.D. a 1.5T Siemens MAGNETOM Avanto clearly demonstrated in the right
scanner using a Body Matrix coil. lung corresponding to the known
University Hospital Tübingen, Images were acquired during chondromas. A tumor of the esopha-
Dept. of Radiology, breath-hold after deep inspiration gus was not detected. The contrast
Tübingen, Germany without ECG triggering. enhanced MR angiography showed
First, transversal imaging was no abnormality.
performed using a T2-weighted STIR,
Introduction a T1-weighted FLASH 2D and a PD
weighted volumetric interpolated Discussion
Carney’s triad was described in 1997 3-dimensional breath-hold (VIBE) Carney’s triad [1] is a rare disease
in two young female patients pre- sequence with fat saturation. Axial with approximately 60 cases world-
senting with gastric leiomyosarcoma, images based on the VIBE sequence wide. A genetic disorder was suspect-
paraganglioma outside the adrenal were also used for coronal recon- ed, although up to now this could
gland, and pulmonary chondroma struction. not be confirmed. The detection of
[1]. Typically, manifestation of this 2 ml Gadolinium-DTPA were the tumors is essential for prognosis
disease occurs in early adulthood injected with high flow to measure and therapy of patients, which
whereas specific tumor entities may the circulation time. Subsequently, necessitates early diagnosis. Gastro-
develop over years or decades. a coronal FLASH 3D with 128 slices intestinal tumors are part of the
Gastrointestinal tumors which are per slab, slice thickness = 1.0 mm syndrome and hazardous for the
part of the syndrome are especially and an acquisition time of less than patient. MRI can be helpful in visual-
hazardous for the patient and require 20 seconds was measured before izing intrapulmonary chondromas,
early resection. and after bolus injection of 0.15 which supports the diagnosis, and for
mmol Gd-DTPA/kg body weight. visualizing or ruling out gastro-
Angiographic images were acquired intestinal tumors, which require early
Patient History during end-expiratory breath holding surgical resection.
26 year old female patient with in order to improve image quality of
known Carney’s triad status post subtracted images. [ 1 ] Carney JA, Sheps SG, Go VL, Gordon H.
The triad of gastric leiomyosarcoma, function-
gastrointestinal tumor excision. After contrast administration ing extra-adrenal paraganglioma und pul-
Conventional contrast-enhanced axial Flash 2D and VIBE sequences monary chondroma.
N Engl J Med, 1977; 296 (26): 1517–1518.
CT was done to assess pulmonary were repeated with fat saturation.
nodules which were detected first on
conventional plain films; MRI was
also acquired to rule out a suspicious
tumor in the oesophagus and to
compare the findings with the CT.
Sequences
Orientation TI TR TE BW FA FoV Matrix No Slice th. Gap iPAT TA

(ms) (ms) (ms) (Hz/Px) (°) (mm x mm) (mm x mm) sl. (mm) (s)
STIR Tra 130 4510 97 250 133 235 x 320 141 x 256 40 6 0.33 2 30 Mbh
Flash 2D Tra 196 4.8 200 70 219 x 350 208 x 512 40 5 0.20 Off 40 Mbh
VIBE 3D Tra 3.4 1.2 455 5 219 x 350 120 x 192 63 1.8 Off 2 x 20 Bh,FS
Flash 3D (angio) Cor 2.5 1.0 685 15 390 x 390 246 x384 128 1.0 2 19 Bh
VIBE 3D (p.cm) Tra 4.3 2.1 360 10 241 x 350 236 x 512 72 3 Off 22 Bh,FS

CLINICAL
THORAX
VIBE 3D VIBE 3D VIBE 3D
VIBE 3D VIBE 3D

CLINICAL
THORAX
FLASH 2D FLASH 2D VIBE 3D
VIBE 3D VIBE 3D FLASH 2D
FLASH 2D FLASH 2D
CLINICAL
THORAX
MRA MIP view MRA MIP view
MRA MIP view MRA MIP view

CLINICAL
WHOLE BODY
Case Report:
Whole Body MRI
Ulrich Kramer, M.D. Examination axial T1-weighted SE sequences for
Michael Fenchel, M.D. brain, T1-weighted FLASH 2D with
Katrin Tomaschko Examination was performed on a fat saturation for the neck, abdomen
Heinz-Peter Schlemmer, M.D. 1.5T Siemens MAGNETOM Avanto and pelvis and a T1-weighted fat
scanner using head-, neck-, spine-, saturated VIBE for the thorax were
University Hospital Tübingen, peripheral angiography – and two acquired. 40 mg of n-butyl-scopo-
Dept. of Radiology, Body Matrix coils. lamide (Buscopan, Boehringer,
Tübingen, Germany Five segments were planned for Germany) were administered intra-
complete cranio-caudal coverage venously just before abdominal MRI
with overlap between two adjacent to suppress bowel peristalsis.
Introduction segments of at least 40 mm. Segment
one encompassed head and upper
Secondary osseous involvement is thorax, segment two lower thorax Findings
relatively common in both Hodgkin’s and abdomen, segment three pelvis, 1. Head/neck: NAD, particularly no
disease and non-Hodgkin’s lym- segment four upper leg and segment tumor suspicious lymph nodes
phoma (up to 16% of cases). As five lower leg. were detected
patients with low-grade lymphomas Firstly, STIR sequences using
frequently receive high-dose therapy parallel imaging (GRAPPA, PAT factor 2. Thorax: lymph node involvement
with hematopoietic support, the 2) were performed in coronal orien- next to the left internal mammar-
diagnosis of bone marrow involve- tation for all five segments. Field of ian artery, pulmonary nodules
ment is very important. Today, bone view (FoV) was 480 mm in each case, in left (diameter: 34 mm) and
scintigraphy is not widely used in the yielding 2020 mm head to feet right lung (diameter: 44 mm);
staging of malignant lymphomas, coverage. extramedullary involvement left
due to potential false-positive results Secondly, brain, neck, thorax, to thoracic vertebrae 10-12.
by skeletal accumulation of the tracer abdomen and pelvis were examined
which is not specific to malignancy. with T2-weighted sequences as 3. Abdomen/pelvis: splenomegaly,
Although CT has been used for eval- well as precontrast T1-weighted multiple tumor suspicious lesions
uation of the presence and location sequences in axial orientation. Post- in liver and spleen, tumor suspi-
of malignant lymphoma, MRI of the contrast T1-weighted fat suppressed cious bone marrow changes,
bone marrow is a noninvasive and images were acquired after injection especially in ilium and sacrum.
nonradiation imaging method, which of 0.1 mmol Gadolinium-DTPA
can be used to assess stage and prog- (Magnevist, Schering, Germany).
nosis of the disease and to monitor T2-weighted imaging was per- Discussion
the therapeutic response. formed using a fluid attenuated MRI has high sensitivity for visual-
Bone marrow imaging by MRI has inversion recovery sequence (FLAIR) izing bone marrow involvement in
proven to be a sensitive technique for the brain, STIR sequences for the malignant diseases, particularly with
for determining bone marrow involve- neck, thorax and pelvis and a TSE STIR or fat-suppressed T2-weighted
ment in malignant lymphomas, where- sequence with fat saturation for the MR images providing high contrast
as whole-body MRI has been success- abdomen. While thoracic images between tumor and uninvolved bone
fully used to visualize metastatic bone were acquired in breath-hold tech- marrow. Moreover, MRI allows to
lesions caused by malignant tumors. nique, the abdomen was examined demonstrate extramedullary tumor
using navigator triggered sequences. involvement in lung, abdominal and
Precontrast T1-weighted MRI was pelvic organs as well as soft tissue.
Patient History performed using a SE sequence for Whole-body MRI is consequently an
52 year old male patient with known the brain and a FLASH 2D with fat effective method for a comprehen-
non-Hodgkin’s lymphoma involving saturation for the abdomen. The sive evaluation of both bone marrow
lungs, liver, spleen and gastrointesti- thorax was imaged using a PD- and extramedullary involvement of
nal structures. MRI was requested in weighted volumetric interpolated the entire body in patients with non-
addition to conventional contrast- 3-dimensional breath-hold (VIBE) Hodgkin’s lymphoma.
enhanced whole-body CT for precise sequence with fat saturation. After
tumor staging and follow-up. contrast application, coronal and

CLINICAL
WHOLE BODY
Sequences
Orientation TI TR TE BW FA FoV Resolution No Slice th. Gap iPAT TA

(ms) (ms) (ms) (Hz/Px) (º) (mmxmm) (mmxmmxmm) slices
STIR Cor 150 9760 87 305 150 480 1.8 x 1.3 x 5.0 30 5 mm 0.20 2 2:36 min
(head/thorax)
STIR Cor 150 5800 87 305 150 480 1.8 x 1.3 x 5.0 38 5 mm 0.20 2 3:06 min
(thorax/abd)
STIR Cor 150 8540 87 305 150 480 1.8 x 1.3 x 5.0 30 5 mm 0.20 2 2:17 min
(pelvis/upper leg)
STIR Cor 150 7020 87 305 150 480 1.8 x 1.3 x 5.0 25 5 mm 0.20 2 1:52 min
(up.leg/ knee)
STIR Cor 150 8670 87 305 150 480 1.8 x 1.3 x 5.0 25 5 mm 0.20 2 2:02 min
(knee/ lower leg)
Flair (brain) Tra 2500 8510 108 130 150 230 1.2 x 0.9 x 4.0 30 4 mm 0.10 Off 2:40 min
T1 se (brain) Tra 500 8 130 90 230 0.9 x 0.9 x 4.0 30 4 mm 0.10 Off 2:48 min
STIR (neck) Tra 150 6180 59 130 150 220 1.2 x 0.9 x 5.0 40 5 mm 0.20 2 2:17 min
STIR (thorax) Tra 150 4480 100 250 146 380 1.8 x 1.2 x 6.0 30 6 mm 0.33 2 0:48 min mbh
VIBE 3D (thorax) Tra 3.37 1.21 455 5 380 2.0 x 2.0 x 2.0 72/slab 2 mm Off 0:20 min x2 Bh, FS
T2 tse fs Tra 6859 95 300 150 380 1.6 x 1.2 x 6.0 40 6 mm 0.33 2 1:46 min trigger, FS
(abdomen)
Flash 2D fs Tra 242 4.10 140 70 380 2.1 x 1.5 x 6.0 40 6 mm 0.33 2 0:59 min mbh, FS
(abdomen)
STIR (pelvis) Tra 150 7100 70.00 130 150 360 1.3 x 1.0 x 4.0 40 4 mm 0.25 2 4:31 min
Flash 2D fs Tra 216 4.10 140 70 360 2.1 x 1.5 x 4.0 40 4 mm 0.25 2 0:57 min FS
(pelvis)
(abdomen)
VIBE 3D fs Tra 3.37 1.21 460 20 380 2.0 x 2.0 x 2.0 72/slab 2 mm Off 0:20 min x 2 FS
(thorax)
(neck)

CLINICAL
WHOLE BODY
T2 TSE fs VIBE 3D FLASH 2D fs
FLASH 2D fs FLASH 2D fs FLASH 2D fs
T2 TSE fs STIR STIR
STIR STIR
CLINICAL
WHOLE BODY
STIR STIR STIR

CLINICAL
WHOLE BODY
STIR STIR STIR

CLINICAL
WHOLE BODY
STIR STIR STIR

CLINICAL
WHOLE BODY
STIR STIR STIR

CLINICAL
WHOLE BODY
STIR STIR STIR

CLINICAL
WHOLE BODY
STIR STIR

CLINICAL
WHOLE BODY
STIR STIR

CLINICAL
EXTREMITIES
Case Report:
MRI of the Lower Extremities
Michael Fenchel, M.D. Examination femur diaphysis (left side) an in-
Ulrich Kramer, M.D. tramedullary signal enhancement
Katrin Tomaschko Examination was performed on a (size 4.0 cm) can be observed, with-
Heinz-Peter Schlemmer, M.D. 1.5T Siemens MAGNETOM Avanto out affection of the cortical bone.
scanner. The child was positioned No sign of periostal involvement.
University Hospital Tübingen, feet first supine in the magnet. The Additional signal increase on STIR
Dept. of Radiology, Pelvis and the legs of the patient MR images and contrast enhance-
Tübingen, Germany were covered with a Body Matrix and ment at the level of the tibial plateau.
the Peripheral Angiography Matrix In the distal femoral metaphysis
coil. Four spine elements were also (right side), an additional tumorous
Patient History used on each station to increase the lesion was detected which crosses
signal. the epiphyseal border.
MRI was performed on a 10 year T2-weighted STIR sequences and Extensive tumorous involvement
old male patient who already had a T1-weighted spin echo sequences of the tibila plateaus on both sides,
previous MR examination of the were measured in coronal and axial the right distal femur and the left
ankle several days before. Due to slice orientation on two stations with distal femoral diaphysis. Widespread
image findings, suspicious for an sufficient overlap. T1-weighted lymphoma of the left inguinal and
osteosarcoma, a whole body scintig- sequences were repeated with fat iliac region. Due to serological data,
raphy was conducted which shows saturation after the injection of an inflammatory disease can be ruled
enhancement of the proximal tibia, Gadolinium-DTPA (0.1 mmol/kg body out. Secondary to the multifocal
the knee and the femur. No abnor- weight). Subsequently, coronal affection there is evidence of a
malities were detected on plain x-ray images were composed for a “whole- lymphoma in conjunction with an
films of the distal tibia. leg-image” for improved visualization osteosarcoma.
For additional information, MR of the tumor.
images of the pelvis, the upper and
lower leg were acquired to determine Discussion
tumor location as well as tumor Findings The large field-of-view of the
spread. Extensive lymph node packages were MAGNETOM Avanto was helpful for
detected in the inguinal and iliac evaluating all tumor-involved regions
region on the left side. Singular lymph as compared to initial MR imaging
nodes measure up to 3.5 x 3.0 cm. restricted to the lower legs.
Marked signal enhancement on STIR Novel image post-processing
MR images and post contrast images techniques using the “Composing”
secondary to inflammatory signs of Tab Card allow for an improved
the surrounding tissues. In the distal visualization of all body regions.
Sequences
Orientation TI TR TE BW FA FoV Matrix No Slice th. iPAT TA

(ms) (ms) (ms) (Hz/Px) (°) (mm x mm) (mm x mm) sl. (mm) (min)
STIR Cor 150 8540 87 305 150 480 x 480 269 x 384 28 5 2 2:20
(pelvis/upper leg)
STIR Cor 150 4580 87 305 150 480 x 480 269 x 384 30 5 2 2:18
(knee/lower leg)
STIR Tra 150 7620 69 130 150 227 x 351 133 x 256 50 6 2 2:00
SE Tra 546 13 150 90 219 x 350 129 x 256 50 6 2 2:00
SE p.KM Tra 687 13 150 90 219 x 350 112 x 256 50 6 2 3:00 FS
SE p.KM Cor 568 13 150 90 480 x 480 179 x 256 28 5 2 3:00 FS
(pelvis/upper leg)
SE p.KM Cor 609 13 150 90 480 x 480 179 x 256 30 5 2 3:10 FS
(knee/lower leg)

CLINICAL
EXTREMITIES
STIR STIR STIR
STIR STIR STIR

CLINICAL
UROGRAPHY
Case Report:
MR-Urography
Ulrich Kramer, M.D. Examination after 25 minutes, using a T1-weight-
Michael Fenchel, M.D. ed sequence with fat saturation.
Katrin Tomaschko MR images were acquired on a
Heinz-Peter Schlemmer, M.D. 1.5T Siemens MAGNETOM Avanto
scanner using two standard Body Findings
University Hospital Tübingen, Matrix coils. The patient was placed MRI was performed to assess the
Dept. of Radiology, in supine position, 40 mg of n-butyl- whole urinary tract including kidneys
Tübingen, Germany scopolamide (Buscopan, Boehringer, and the ileum-bladder and to exclude
Germany) were administered intra- recurrence of the tumor.
venously to suppress bowel peristalsis. No tumor was detected. Distal
Patient History Coronal HASTE images provide initial ureter stenosis secondary to scar
information about the abdominal tissue was treated by dilatation.
A 68 year old male patient status anatomy. The urinary bladder was
post radical prostatectomy and examined using an axial T2-weighted
urinary bladder resection because of TSE sequence. Subsequently, the Discussion
urothelial carcinoma. Construction of table was moved and T1- and T2- Heavily T2-weighted urography
a neo-bladder using the ileum. The weighted axial images covering the without contrast agent is feasible
patient is now presenting with kidneys were acquired using breath- yielding state-of-the-art image quality.
urinary retention to the left kidney. hold and navigator triggering tech- In this case a contrast enhanced
Renal function was assessed by niques. For the urography without urography was performed, as the
scintigraphy: left/right kidney contrast agent, we used a heavily patient had received Gadolinium for
15.5%/84.5%. T2-weighted 3D sequence with the assessment of renal perfusion,
navigator triggering. Contrast media despite excellent diagnostic quality
was administered to analyze the of precontrast urographic images.
perfusion of the kidneys. Contrast
enhanced urography was performed
Sequences
Orientation TR TE BW FA FoV Matrix No Slice th. Gap iPAT TA

(ms) (ms) (Hz/Px) (°) (mm x mm) (mm x mm) sl. (mm) (s)
HASTE Cor 900 118 490 106 500 x 500 412 x 512 40 5 0.20 Off 0:30 Mbh
(abdomen)
T2 TSE Tra 5700 130 130 137 321 x 400 278 x 384 40 4 0.25 2 3:10
(bladder)
Flash 2D Tra 187 4.1 140 70 375 x 400 167 x 256 36 5 0.20 2 0:36 Mbh
(kidneys)
T2 TSE FS Tra 3890 96 300 150 400 x 400 240 x 320 36 5 0.20 2 1:46 Trigger
(kidneys)
T2 TSE (kidneys) Tra 3100 100 260 150 369 x 400 284 x 512 36 5 0.20 Off 0:40 Mbh
TrueFISP (abdomen)Tra 3.3 1.4 750 60 400 x 400 220 x 256 40 6 0.33 Off 0:30 Mbh
T2 TSE 3D Cor 3713 678 260 180 450 x 450 380 x 384 40 1.5 2 3:42 Trigger
(urography)
T1 SE FS Cor, tra,sag 662 13 150 90 280 x 280 179 x 256 30 3 0.33 2 3:20 FS
(bladder)
Flash 2D FS Tra 107 2.9 210 70 375 x 400 336 x 512 60 5 0.20 Off 1:30 Mbh, FS
(abdomen)
Flash 3D Cor 3.1 1.1 425 25 500 x 500 308 x 512 80 1.5 2 0:18 Bh
(urography)

CLINICAL
UROGRAPHY
T2-weighted 3D TSE, Maximum Intensity Projection (MIP) images.

CLINICAL
PEDIATRIC
Case Report:
Pediatric MRI of the Hepatobiliary System
Michael Fenchel, M.D. Examination Discussion
Ulrich Kramer, M.D.
Katrin Tomaschko Examination was performed on a Assessment of the pancreato-biliary
Heinz-Peter Schlemmer, M.D. 1.5T Siemens MAGNETOM Avanto system without contrast agent is a
scanner using a standard 8 channel valuable tool in pediatric and adult
University Hospital Tübingen, head coil. After the child was sedated patients. The use of PACE navigator
Dept. of Radiology, and 5 mg of butyl-scopolamide triggering and parallel imaging
Tübingen, Germany (Buscopan, Boehringer, Germany) techniques is particularly promising
were administered to suppress bowel because heavily T2-weighted 3D data
peristalsis, T2- and T1-weighted sets can be acquired within reasonable
Patient History images were obtained to get an imaging times depicting the anatomy
anatomical overview. The T1-weight- of the pancreato-biliary system in
4 months old male patient with ed sequence was acquired with four great detail.
a history of choleocysto- and repetitions to decrease respiratory
choleodocholithiases; no concre- movement; the T2-weighted
ments were detected on ultrasound. sequences were measured during
free breathing using PACE (Prospec-
tive Acquisition CorrEction) navigator
triggering. After localizing the bile
ducts, a heavily T2-weighted coronal
TSE 3D sequence was measured
with PACE navigator technique.
T2-weighted coronal TSE 3D images
were post-processed using a maxi-
mum intensity projection (MIP)
algorithm.
Findings
Discrete dilatation of intrahepatic
biliary ducts (up to 6 mm). Irregular
shape of the ductus choledochus.
Evidence of concrements in the gall
bladder as well as prepapillary con-
crements in the hepatobiliary duct
(size 3 and 1.2 mm). Normal appear-
ance of other abdominal organs and
structures. There is no evidence of The safety of imaging (fetuses, infants)
a significant cholangitis. has not been established.
Sequences
Orientation TR TE BW FA FoV Matrix No Slice th. iPAT TA

(ms) (ms) (Hz/Px) (°) (mm x mm) (mm x mm) sl. (mm) (min)
HASTE Cor 1100 119 490 120 175 x 200 179 x 256 22 4 2 0:29
T1 TSE Tra 465 16 250 150 129 x 180 294 x 512 30 4 2 4:30
T2 TSE FS Tra 3010 71 300 150 125 x 196 153 x 320 30 4 2 3:00 FS
T2 TSE FS Cor 2995 71 300 150 180 x 200 216 x 320 22 4 2 3:10 FS
T2 TSE 3D Cor 2767 683 260 180 200 x 200 380 x 384 44 1.5 2 4:34

CLINICAL
PEDIATRIC
T2-weighted 3D TSE.


CLINICAL
MRA
Case Report:
Whole Body MRA
Ulrich Kramer, M.D. Examination Findings
Michael Fenchel, M.D.
Katrin Tomaschko Examination was performed on a Normal anatomy of intracranial
Stephan Miller 1.5T Siemens MAGNETOM Avanto arteries as well as common carotid
scanner using standard Head-, Neck-, arteries and internal carotid arteries.
University Hospital Tübingen, Spine-, Peripheral Angio- and two There is a low grade stenosis of the
Dept. of Radiology, Body Matrix coils. external carotid arteries. Normal
Tübingen, Germany The patient was placed in supine depiction of thoracic, abdominal
position with pads under each knee aorta and great thoracic vessels.
to reduce the venous backflow. Both kidneys are supplied by two
Introduction Venous access was established on renal arteries; one renal artery of the
the right cubital vein to avoid over- right kidney which exhibits a hemo-
The early detection of atherosclerotic lapping with the left subclavian dynamically relevant stenosis.
vascular lesions is very important for artery in the maximum intensity An occlusion of the left common
diagnostic and interventional purposes. projection (MIP). iliac artery as well as a high grade
Magnetic resonance angiography Four angiographic stations were stenosis of the right common iliac
(MRA) has increasingly gained accept- acquired to obtain whole-body artery can be found. Complete
ance as a valid alternative to conven- coverage. Station I included cranial occlusion of the distal superficial
tional digital subtraction angiography and thoracic vessels, station II tho- femoral arteries on both sides with
for many vascular regions. The racic, abdominal and pelvic vessels, collaterals to normal perfused lower
systemic distribution of atheroscle- station III vessels of the upper leg and leg arteries.
rotic manifestations requires the use station IV vessels of the lower leg.
of techniques which can assess the Field of view (FoV) was 500 mm for
vascular system as exhaustively as each station and overlap between Discussion
possible. The recent introduction of two stations was at least 40 mm. The presented technique is very
whole-body MR scanners with sur- After acquisition of localizer promising for a comprehensive
face coil technology raises the possi- images in all four regions, a phase- staging of vascular involvement of
bility of whole-body MRA examina- contrast vessel scout was obtained systemic atherosclerotic disease.
tions providing information of the for each station. Novel scanner and coil technology
patient’s complete arterial vasculature. A test bolus (2 ml Magnevist) was enable whole-body MRA examina-
injected to determine contrast circu- tions without patient repositioning
lation time according to the follow- while providing high SNR in short
Patient History ing formula: [circulation time – time measuring times.
Whole body MRA was performed on to k-space center + 4 seconds].
a 45 year old male patient with sus- Subsequently, a multislab time-of-
pected peripheral arterial occlusive flight (TOF) sequence (TR = 36 ms,
disease (Fontaine 2b). According to TE = 7.15 ms, FoV = 220 mm,
patient history and clinical findings, Flip = 30°, BW = 73Hz/Px, slice thick-
arterial obstruction is suspected at ness = 0.80, gap = -34%, voxel size:
the level of the upper leg. 0.8 mm x 0.6 mm x 0.8 mm) employ-
Prior angiographic examinations ing a TONE pulse was used to depict
were performed in 1992 and March the cranial arterial vessels with
of 2004. However, due to atheroscle- sufficient spatial resolution.
rotic occlusions of the pelvic arteries, Precontrast and postcontrast
only an intravenous DSA could be images of all regions were acquired
performed. using an angiographic FLASH 3D
MR images should be acquired to sequence in coronal orientation (see
assess the vascular status of the table for sequence details).
complete arterial vasculature of the
body.

CLINICAL
MRA
Sequences

CLINICAL
MRA
Orientation TR TE BW FA FoV Matrix No Slice th. iPAT TA

(ms) (ms) (Hz/Px) (°) (mm x mm) (mm x mm) sl. (mm) (min)
Flash 3D Cor 2.85 1.68 650 25 344 x 500 264 x 512 88 1.6 2 0:17 Bh
(head/thorax)
Flash 3D Cor 3.11 1.14 420 25 375 x 500 230 x 512 80 1.5 2 0:13 Bh
(abdomen)
Flash 3D Cor 3.46 1.21 360 25 375 x 500 230 x 512 64 1.5 2 0:12
(upper leg)
Flash 3D Cor 3.46 1.21 360 25 375 x 500 230 x 512 80 1.3 Off 0:26
(lower leg)
TOF Tra 36 7.15 73 30 180 x 240 202 x 384 84 0.8 Off 5:30
(brain vessels)

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TECHNOLOGY
FATSAT
All You Want to Know about FatSat
David Purdy, Ph.D. permits more of the slices to have each phase encoding, so there is no
poorer saturation. This allows the difference between quick saturation
MR R&D user to adjust the trade-off between mode and standard mode.
Research & Collaborations, imaging time and fat saturation
USA quality when speed is essential, often Quick FatSat with 2D Sequential
for breath-hold imaging. Slice
The saturation pulse must be applied
Quick FatSat with 2D Multislice for each phase encoding, so there is
Since the effect of a saturation pulse no difference between quick satura-
does not disappear immediately, and tion mode and standard mode.
Quick FatSat since the GRE sequence acquires data
rapidly, one Fourier line from several Quick FatSat with the 3D GRE
slices can be acquired after a single Sequence
What is Quick FatSat and why do saturation pulse. Naturally, the first For a single slab (or multiple, sequen-
we need it ? slice acquired following the satura- tial slabs), the quick and standard
Fat and water saturation pulses take tion pulse will show better saturation saturation modes are identical. For
so much time compared to the rest of than the last, so the user is allowed multiple interleaved slabs, the quick
a gradient echo sequence that acqui- some control over how many slices mode works as described above for
sition times become nearly as long are acquired before the next satura- interleaved slices. For 3D, users
as the corresponding spin echo tion. should select the “weak” Q-fat sat
sequence. In standard saturation For strong Quick fat sat mode, mode to avoid a system problem
mode, saturation pulses are applied the system acquires as many different with the “strong” mode. For a faster
before every phase-encoding step of slices as possible between FatSat acquisition with good fat suppres-
every slice. The quick saturation pulses, provided that the time between sion, a water excitation pulse should
mode provides a significant reduction saturation pulses does not exceed be considered.
in imaging time by using fewer about 50 ms. This amounts to roughly
saturation pulses while maintaining four slices between saturation pulses,
a reasonable level of fat or water greatly increasing the time efficiency Quick FatSat:
suppression. This technique is only of the sequence. For the “weak” fat Some Examples
available for the gradient echo sat mode, the time between satura- A concrete example is helpful for
sequence. tion pulses does not exceed about explaining how Quick FatSat works.
75 ms, further increasing time effi- Here is my test case :
How is Quick FatSat used with ciency at the cost of poorer fat I used the gradient echo sequence
syngo? suppression for a few of the slices. on a MAGNETOM Symphony Quantum,
Choose two or more slices to ensure You can obtain the maximum regular gradient mode, regular RF
that the Saturation mode selection number of slices per FatSat pulse mode, 260 Hz/pixel bandwidth, one
is active in the Saturation subcard of if you increase the number of segment, minimum TE, and minimum
the Geometry card. Select Saturation slices to the final value, rather than TR. For acquisition time measure-
mode = Quick. Then select Q-fat sat decreasing the number. ments, I used a 256 x 256 matrix.
or Q-water sat. If only two slices are acquired, To describe what is happening,
there are only two slices between I need to define a couple of words.
Quality versus imaging time saturation pulses, and there is no I will call that part of the sequence
In quick saturation mode, gradient difference between “strong” and that excites the slice, phase-encodes
echo slices are acquired with varying “weak” quick saturation modes. The it, and reads out the data the “imaging
degrees of saturation. The “strong” same will usually be true for three module.” The duration of the imaging
option gives more slices with good and four slice protocols. The gradient module is the same as the minimum
fat saturation in a relatively short echo sequence does not change the TR of the sequence (without satura-
imaging time. Even shorter acquisi- FatSat flip angle to create brighter or tion pulses) when one slice is imaged.
tion times are available with the darker fat. This is a few milliseconds longer than
“weak” option, which also gives some If only one slice is acquired, the TE. For my test case, TE is 3.76 ms
slices with good fat saturation, but saturation pulse must be applied for and the imaging module takes 7.7 ms.

TECHNOLOGY
FATSAT
I will call the FatSat RF pulse and the These considerations lead naturally Fourier line has good fat suppression,
following spoiler gradient the “FatSat to the Quick saturation method: and the two images do also. TR is the
module.” For the GRE sequence, more than one imaging module may sum of the durations of two FatSat
the FatSat or Water sat module takes be placed after a FatSat module. This and two imaging modules (20 + 20 +
about 20 milliseconds. technique was originated by Dr. Paul 7.7 + 7.7 = 55.4 ms). The time be-
The operation of the quick satura- Finn (U.S. patent 5.633.586). The tween the centers of the FatSat
tion mode is governed by several sequence diagrams are rather differ- modules is (20 + 7.7 = 27.7 ms). The
concepts or rules. ent for one slice, a few slices, and desirable short acquisition time of
many slices, and I will treat these the GRE sequence is lost when FatSat
Rules: separately. is added in this manner – the FatSat
module takes up 20/27.7 = 72% of
1. The effectiveness of the FatSat the overall imaging time.
pulse decays over time: 30 ms Quick Sat – The Quick saturation mode saves
after the pulse, the fat suppression Small number of slices time by inserting the imaging mod-
is only “fair”; 55 ms after the pulse, The advantage of Quick saturation ules for slice 2 immediately after the
the suppression is just adequate. is most easily diagrammed for two modules for slice 1 (Figure 2). This
For the standard FatSat technique, slices. eliminates half (256) of the FatSat
only one imaging module is placed modules from the acquisition. The fat
after each FatSat module, so that Figure 1 shows a two-slice inter- suppression for slice 2 is not as good
the strongest saturation is ob- leaved multislice sequence with as that for slice 1, but it is acceptable
tained. However, additional imag- standard FatSat: as long as not too much time has
ing modules (e.g., slices) may be Each imaging module acquires elapsed between the FatSat pulse
placed after the first. This reduces one Fourier line, and each is directly and the second slice module. The
imaging time. Images reconstruct- preceded by a FatSat module. Each syngo Quick sat mode guarantees this.
ed from these later imaging mod-
ules will have poorer fat satura-
tion. Standard saturation, 2 slices
2. The time between the imaging

modules for a particular slice is TR.
FatSat S1 FatSat S2 FatSat S1 FatSat S2 FatSat S1 FatSat S2
To avoid serious artifacts, the TR L1 L1 L2 L2 L3 L3
for all 256 Fourier lines must be
TR
the same. FatSat imaging
module module
3. To maintain the same clinical

contrast for every slice, the TR of Figure 1 Each imaging module is labeled with the spatial slice position (S) and
each slice should be the same. the Fourier line number (L). The horizontal axis is time. The 2 slice, 256 line
acquisition has 512 FatSat modules.
4. To avoid artifacts, the time
between the FatSat module and QuickSat, 2 slices, “strong” or “weak”
the imaging module for a partic-
ular slice should be the same for
all 256 Fourier lines.
FatSat S1 S2 FatSat S1 S2 FatSat S1 S2 FatSat S1 S2 FatSat
L1 L1 L2 L2 L3 L3 L4 L4
5. It is not necessary for the time
TR
between FatSat pulses to be
constant. F-F time
Figure 2 Compared to the standard saturation mode in Figure 1, the FatSat

module now only takes up 56% of the total imaging time. The time between
FatSat modules (center-to-center or end-to-end) is labeled “F-F time.”

TECHNOLOGY
FATSAT
TR has been reduced to one

FatSat module and two imaging Standard FatSat, 10 slices
modules (20 + 7.7 + 7.7 = 35.4 ms),
and the total imaging time (256 x TR)
has been reduced from 14.2 seconds FatSat S1 FatSat S3 FatSat S5 FatSat S7 FatSat S9 FatSat S2
L1 L1 L1 L1 L1 L1
in standard mode to 9.1 seconds
in Quick sat mode, a time saving of TR
36%.
The fat saturation of the second
slice in Figure 2 is still fairly good, so FatSat S4 FatSat S6 FatSat S8 FatSat S 10 FatSat S1
L1 L1 L2 L1 L2
more imaging modules (slices) may be
added between the FatSat pulses. TR (continued)
Since each additional slice has poorer
saturation, we cannot insert too
many slices between FatSat modules. Figure 3 TR is the duration of ten FatSat pulses and ten imaging modules.
The user is given some control over As in Figure 1, the FatSat module takes up 72% of the overall imaging time.
the tradeoff between speed and
FatSat quality. In “strong” mode, the
FatSat-to-FatSat time (measured QuickSat algorithm, 10 slices, “strong”
from the pulse centers) will not
exceed about 50 milliseconds (four Repeating Block (TR)
slices for our test case). In “weak”
FatSat S1 S3 S5 S7 FatSat S9 S2 S4 FatSat S6 S8 S 10 FatSat S1 S3
mode, the time limit is about 75 ms L1 L1 L1 L1 L1 L1 L1 L1 L1 L1 L2 L2
(seven slices for our test case). One
F-F time #1 F-F time #2
measure of the efficiency of these
modes is how much time is wasted
on the long FatSat pulses. When we
acquire 4 slices per FatSat, only 39% Figure 4 TR is the duration of three FatSat pulses and ten imaging modules.
of the acquisition time is spent on The FatSat module takes up 44% of the overall imaging time.
the FatSat module, for 7 slices per
FatSat, only 27%.
#2), because the slice only appears efficient when the number of
once in the repeating block. The TR requested slices is a multiple of four,
Quick Sat – for all of the slices is the same (Rule but it is not possible to make the
Large number of slices #3), because the 10-slice block 10-slice sequence more efficient by
The pattern of FatSat and imaging repeats. The time between a FatSat having four imaging modules be-
modules changes when we request pulse and a particular slice is con- tween every pair of FatSat modules.
more slices. Figure 3 shows 10 inter- stant (Rule #4) for the same reason. Figure 5 shows that the pattern does
leaved slices acquired in standard The time between the first and the not repeat after 10 slices.
FatSat mode. The slice numbers second FatSat pulses is longer than The first TR for slice 1 is the
represent physical positions, and the between the other FatSat pulses – duration of 10 imaging modules and
interleaving is assumed to be odd this does not cause significant arti- 2 FatSat modules, but the next TR for
slices before even (Fig. 3). facts (Rule #5). It is important to note this slice is 10 imaging modules and
Figure 4 shows 10 interleaved that slices 1, 9, and 6 are acquired 3 FatSat modules. This violates Rule
slices in “strong” Quick sat mode. For directly following a FatSat pulse, and #2, and would lead to unacceptable
this example, only 4 slices are permit- will show maximal fat suppression. artifacts. Rule #4 is also violated.
ted after each FatSat pulse (Fig. 4). Slices 3, 2, and 8 will show some- For quick saturation, “weak”
The maximum time between what less suppression, and slices 5, mode gains time efficiency at the
FatSat pulses is 50.8 ms, just at the 4, and 10 less still. cost of a few slices with diminished
limit for the “strong” algorithm. The Figure 4 should make it clear that fat suppression. For the example
TR for any one slice is constant (Rule the sequence in this example is most case, seven imaging modules can be

TECHNOLOGY
FATSAT
inserted between the FatSat pulses

Bad algorithm, 10 slices without exceeding the 75 ms FatSat-
to-FatSat limit. Figure 6 shows a 14-
slice example.
FatSat S1 S3 S5 S7 FatSat S9 S2 S4 S6 FatSat S8 S 10 S 1 S3 FatSat Note that slices 1 and 2 in the
L1 L1 L1 L1 L1 L1 L1 L1 L1 L1 L2 L2
“weak” example of Figure 7 have
TR #1 TR #2 the same strong fat suppression as
slices 1, 9, and 8 in the “strong”
example of Figure 4. The only slices
S5 S7 S9 S2 FatSat S4 S6 S8 S 10 FatSat S1 S3 S5 S7 FatSat in Figure 6 that have weaker satura-
L2 L2 L2 L2 L2 L2 L2 L2 L3 L3 L3 L3
tion than the slices of Figure 4 are
TR #2 (continued) slices 9, 11, 13, 10, 12, and 14.
Figure 5 Four imaging modules are placed between each pair of FatSat puls- Quick Sat –
es. TR #2 continues from the first line to the second. No “weak” and “strong” for
small numbers of slices
The weak and strong modes for quick
QuickSat algorithm, 14 slices, “weak” saturation are only relevant when the
number of requested slices is larger
Repeating Block than the number that are allowed
between FatSat pulses for “strong”
FatSat S1 S3 S5 S7 S9 S 11 S 13 FatSat S2 S4 S6 S8 S 10 S 12 S 14 FatSat
L1 L1 L1 L1 L1 L1 L1 L1 L1 L1 L1 L1 L1 L1 mode. For our example, “strong”
mode allows as many as four slices
TR
between FatSat modules; there is no
difference between “weak” and
“strong” protocols for 2-, 3-, or 4-slice
Figure 6 TR is the duration of two FatSat modules and fourteen imaging protocols.
modules. Only 27% of the acquisition time is spent for FatSat.
No Quick Sat for single slice

Single slice, standard or quick Although permitted by the user
interface, there is no Quick sat mode
for single-slice protocols. Standard
saturation, Quick weak saturation,
FatSat S1 FatSat S1 FatSat S1 FatSat S1 FatSat S1 FatSat S1
L1 L2 L3 L4 L5 L6 and Quick strong saturation all follow
the pattern of Figure 7.
TR
FatSat imaging
module module
Figure 7 The only imaging module that could be inserted after slice 1, line 1 No Quick Sat for sequential
would be slice 1, line 2, and this would create Fourier lines with very different slices
TRs (Rule #2), leading to artifacts. Since sequential slice mode acquires
one slice at a time, each slice follows
the pattern of Figure 7. Quick satura-
tion is permitted by the user interface
(no harm is done), but standard
saturation is performed.

TECHNOLOGY
FATSAT
Improving slice efficiency its minimum value, and begin to Quick Sat for
for breath-holds increase the number again. 3D MRA Sequences
Here are the results for the
There is a trick that you can use to example above. TR increases by A different kind of quick saturation is
shorten certain scans by 2-4 seconds. about 4 ms as each slice is added. TR used for some of the 3D angiography
Quick fat saturation is very useful jumps an additional 19 ms as each sequences in single-slab or sequen-
for time-critical imaging tasks such FatSat pulse is added. The acquisition tial slab modes. This allows the
as breath-hold imaging. To acquire as time is TR times the number of lines. acquisition of data for many phase-
many slices as possible during the We expect to get 12 slices per FatSat, encoding steps after each FatSat
breath-hold, we want to get as many and we do indeed get 36 slices with pulse. Because there are fewer 3D
slices between the FatSat pulses three FatSat pulses. However, if we (slice) encodings than in-plane (line)
as possible. This means using a high decrease the number of slices to encodings, these sequences acquire
receiver bandwidth, the shortest the final value, we can get as few as all of the 3D phase encodings after
possible TR, and “weak” mode. 9 slices for one FatSat pulse. each FatSat. For a reasonable num-
For example, using weak mode and ber of 3D partitions, say 32 or more,
a bandwidth of 490 Hz/pixel, it is it is not possible to maintain good
possible to obtain one Fourier line saturation for all of the encodings, so
from 12 slices between the FatSat the important central encodings are
pulses. With this bandwidth and
114 lines, each additional slice adds
0.5 s to the imaging time, and each
FatSat pulse adds 2.16 s. The se-
quence acquires 12 slices in (12 x 0.5 Minimum TR as Minimum TR as
+ 2.16) = 8.16 s, or 1.47 slices per you increase the you decrease the
second. The efficiency drops when Slices no. of slices no. of slices
one more slice (13 total) is requested,
because an additional FatSat pulse 1 24 (same) (24)
must be added, and the imaging time 2 28 (same)
is (13 x 0.5 + 2 x 2.16) = 10.82 s, or (. . .)
1.20 slices per second. 9 59 (same)
Unfortunately, the maximum 10 63 ------------------------- 82
number of slices acquired between 11 68 ------------------------- 87
FatSat pulses varies, depending 12 91 (same)
on how the user types in the number (. . .)
of slices. To obtain the maximum 20 126 (same)
number of slices in the minimum 21 131 (same)
acquisition time for breath-hold appli- 22 135 ------------------------154
cations, use the arrow to increase the 23 140 ------------------------159
number of slices one by one, allow- 24 163 (same)
ing the system to compute the new (. . .)
TR and acquisition time for each step. 33 203 (same)
You will notice a larger jump in TR 34 207 (same)
and acquisition time when the next 35 211 ------------------------230
FatSat pulse is added. For certain 36 216 ------------------------235
numbers of slices, fewer slices per 37 239 (same)
FatSat will be available when you
decrease the number of slices one by
one. If you need to decrease the
number of slices, reduce the number
by at least six slices, reset TR to

TECHNOLOGY
FATSAT
acquired first (“centric reordering”). Conventional FatSat – end of the range of strong values.
This ensures that large regions of fat Strong and weak modes Except for shim problems, all of the
are uniformly saturated in all of the slices for one measurement should
reconstructed slices. This is the What are these modes? have the same fat brightness. Some
standard mode of fat saturation for For conventional (not Quick) FatSat, physicians want very dark bone
these sequences; the user does not “strong” mode gives darker fat than marrow, and use “strong” mode.
need to select any special “quick” “weak” mode. Others feel that marrow lesions are
mode. more easily seen if the marrow is
Why do we use weak mode ? gray, and use the “weak” mode.
Weak FatSat mode prevents the bone The words “weak” and “strong”
Quick Sat – Summary marrow from becoming completely have a completely different meaning
Quick saturation mode is very black, enabling visualization of for the Quick sat mode of the GRE
suitable for breath-hold abdominal marrow lesions. It also keeps the sequence. When many slices are
examinations, where acquisition signal from ligaments hypointense. acquired, one group of slices will
speed is much more important Each slice has essentially the same have good saturation, another group
than slice-to-slice uniformity of fat degree of fat saturation. will show less saturation, the next
suppression. group even less saturation, and so
With which sequences can we use on. In “strong” mode, the slice group
weak and strong modes ? showing the least fat suppression will
“Weak” and “strong” modes are still have relatively good suppression.
available for RF refocused sequences “Weak” mode allows faster acquisi-
(SE, TSE, TGSE, and HASTE). Only tions, but the slice group showing the
standard saturation mode is permit- least fat suppression will have only
ted for these sequences; there is no adequate suppression. These modes
“quick” option. In “strong” mode, an allow the user some choice over this
optimized FatSat flip angle is used to tradeoff. Both “weak” and "strong”
ensure the smallest signal from fat. modes will give some slices with good
This angle varies with TR and the saturation, but we cannot use Quick
number of slices. In “weak” mode, fat sat for consistent control of bone
a fixed flip angle of 90° is used. marrow brightness.
Imaging time is the same for both
modes.
Standard saturation mode is available

for the gradient echo sequences, but
only with a fixed FatSat flip angle –
there is no “strong” or “weak” option.
Spin Echo “weak” and

“strong” versus Gradient Echo
“weak” and “strong”
For RF-refocused (SE, TSE, TGSE,
HASTE) sequences, "weak” and
"strong” adjust the fat brightness of
all of the slices together by changing
the FatSat pulse tip angle. The strong
mode optimizes the tip angle for the
number of slices and TR. The weak
mode uses a fixed tip angle – the low

TECHNOLOGY
MRI SAFETY
MRI Procedures and Transdermal

Medication Patches
Frank G. Shellock, Ph.D. Mucha, Schwarz Pharma, Milwaukee, DERM, NICOTROL, CATAPRES-TTS,
WI; 1995). This injury was likely due and possibly others should be
Adjunct Clinical Professor of to MRI-related heating of the metallic removed prior to an MRI examination.
Radiology and Medicine, foil associated with this transdermal In addition, other patches to be
University of Southern California patch. aware of include the nicotine patch
and Institute for Magnetic The Food and Drug Administra- marketed as Habitrol and its “private
Resonance Safety, Education, tion is aware of at least two other label” equivalents and Scopolamine\
and Research adverse occurrences in which patients Hyoscine HydroBromide, marketed as
www.MRIsafety.com wearing nicotine transdermal patches TransDerm Scop (Personal Communi-
www.IMRSER.org during MRI examinations experi- cation, 5/19/04, Crispin C. Fernandez,
enced burns. In one case, the patient M.D. Medical Affairs, Novartis Con-
entered the MR system wearing sumer Health, Inc. Parsippany, NJ).
a Habitrol transdermal patch. When However, not all medication patches
The use of transdermal patches to the patient was removed from the contain a metallic component.
deliver medications is increasing. A scanner after the MRI procedure, he Accordingly, these patches do not
transdermal patch allows continuous stated that his arm was “burning”. need to be removed for the MRI
and prolonged delivery of a drug Upon examination, his upper left arm examination.
that may be more effective and easier appeared to be mildly erythematous
than oral medication. In addition, and there was a small blister where
patches offer the potential to deliver the patch was located. In another References
medications that would otherwise case, a patient underwent a short http://www.mrisafety.com/
require injections. Future advances in (less than 40 seconds) MRI examina- http://www.fda.gov
technology will expand the utilization tion of the lumbar spine while wear- Institute for Safe Medical Practices, Medication
Safety Alert!, Burns in MRI patients wearing
of drug patches. In fact, researchers ing a nicotine transdermal patch. transdermal patches. Vol. 9, Issue 7, April 8,
are currently working on various Later, the patient complained of burn 2004. http://www.ismp.org/msaarticles/
burnsprint.htm
technologies, including ultrasound lines on his upper arms associated
Shellock FG, Kanal E. Magnetic Resonance:
and electrical charges, to force larger with the patch. Bioeffects, Safety, and Patient Management.
molecules through the skin. These In view of the above, it is highly Second Edition, Lippincott-Raven Press,
so-called “active patches” may permit recommended that any patient New York, 1996.
the delivery of insulin to diabetics, wearing a transdermal patch with a Shellock FG. Reference Manual for Magnetic
Resonance Safety, Implants, and Devices:
as well as the administration of red- metallic component be identified prior Update 2004. Biomedical Research Publishing
cell stimulating erythropoietin for to undergoing MRI. The patient’s Group, Los Angeles, CA, 2004.
treatment of anemia patients without physician should be contacted to de-
injections. termine if it is possible to temporarily
Since 1995, several anecdotal remove the medication patch in
reports have indicated that transder- order to prevent excessive heating.
mal patches containing aluminum After the MRI procedure, a new patch
foil or other similar metallic compo- should be applied following the
nents may cause excessive heating directions of the prescribing physician
or a burn in a patient undergoing an (Personal communication, Robert E.
MRI procedure. In one incident, a Mucha, Schwarz Pharma, Milwaukee,
Deponit (nitroglycerin transdermal WI; 1995). Importantly, this procedure
delivery system) patch, which con- should be conducted in consultation
tains an aluminum foil component, with the physician responsible for
was worn by a patient during MR prescribing the transdermal patch or
imaging. The patient received a otherwise responsible for the man-
second-degree burn during an MRI agement of the patient.
examination performed using The Institute for Safe Medical
conventional pulse sequences and Practices recently stated that medica-
standard imaging procedures tion patches such as ANDRODERM,
(Personal communication, Robert E. TRANSDERM-NITRO, DEPONIT, NICO-

We see a way to seamlessly image up to 100 cm FoV within a single exam
We see a way to position up to 4 coils simultaneously for true multichannel imaging
Results may vary. Data on file.

Small footprint
giant steps
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Siemens Medical Solutions that help

TECHNOLOGY
SIALOGRAPHY
Fast and Ultrafast MR-Sialography
J. Graessner 1, C. R. Habermann 2, tion. This technique is normally used TrueFISP was generally less sen-
M. C. Cramer 2, J. Ussmueller 2, in cardiac coronary imaging. sitive to metallic implants and insuffi-
U. Koch 2, G. Adam 2 All examinations were performed cient fat saturation because a centri-
on a MAGNETOM Symphony cally reordered data-acquisition
1
Siemens AG Medical Solutions, (Siemens AG, Erlangen, Germany) scheme was used after the fat sat
Hamburg, Germany with 30 mT/m Quantum Gradients pulse.
2
University Hospital of Hamburg, and SW version 2002B. The 3D TSE sequence with iPAT
Germany We used the standard CP neck and no partial fourier had much
array coil; only the CP element N1 better image quality combined with
was selected, except for the iPAT ss- 1.5 mm slice-thickness than the con-
Synopsis TSE measurement, where the lower ventional 3D TSE with partial fourier
element of the head coil was select- and same scan time. This protocol
Fast clinical protocols are the back- ed, to form an iPAT array. The flexible delivered the thinnest slices, but had
bone of today’s clinical routine. We part of the coil was positioned around the longest scan time without giving
have therefore developed a program the mandible with the patient’s head further information (Fig. 4).
of 3 fast and ultra fast 3D TrueFISP in the lower part of the head coil. The 3D TrueFISP protocol also
and single-shot TSE sequences for The determination of the optimal allows slice-thickness far below 2 mm
the visualization of the regular ductal TI time for fat saturation was done in a reasonable time by decreasing TR
system of the salivary glands. The by scanning a set of different TI times and/or increasing the segmentation
resulting image quality of the regular from 150 to 400 ms. factor. Interpolation to 512 Matrix
ductal system was so convincing, A TI time of 280 ms showed best enhances the in plane-resolution.
that pathologic changes should be fat suppression (Fig. 5). A sagittal 3D TrueFISP protocol (Fig.
easily detectable. The shift of the optimum TI for fat 11) is helpful for anatomical refer-
suppression in this setup to 280 ms ence.
will be investigated in the future.
Methods
We tried to combine the benefit of Conclusions
a local double-sided surface coil Results Showing the ductal system even in
with fast scan times and optimized Our developed standard protocol healthy volunteers, this protocol is
contrast. included a multiplanar localizer fol- more than sufficient for detection of
For the ss-TSE sequence we lowed by a para-sagittal ss-TSE scan pathologic changes in patients as
switched to fat suppression via inver- (Fig. 1). The next scan was a 50 mm proven by the first clinical results
sion recovery preparation to make transverse ss-TSE measurement (Fig. 6-10).
the technique more robust against displaying all four major salivary
dental implants. Furthermore a reduc- ducts (Fig. 2). Finally, a transverse 3D
tion in TE time compared to the clas- TrueFISP (Fig. 3) was performed to References
sical ss-TSE techniques for cholan- detect anatomical changes and [ 1 ] Becker M, et al. Radiology 2000;
giography gave more contrast-to- pathological masses. An examination 217:347-358.
noise. time of 5 minutes provides a very [ 2 ] Griswold MA, et al.

Proc. of ISMRM/ESMRMB p. 8 (2001).
3 volunteers were examined by comfortable procedure for patients.
[ 3 ] Sakamoto M., et al. Dentomaxillofacial
using 3D Turbo-Spin-Echo (TSE) with The fat saturation with inversion Radiology 2001 30 p.276-284.
fat saturation (FS) and 2D ss-TSE with recovery preparation was beneficial [ 4 ] Jäger L., et al. Radiology 2000;
inversion recovery (IR) preparation compared to the spectral fat satura- 216:665-671.
with and without iPAT (integrated tion due to almost no artifacts from
parallel acquisition technique; self dental implants in the ss-TSE images.
calibrating GRAPPA (2)). Additionally, iPAT factor = 2 added sharpness to
we compared the GRAPPA and Sense the ss-TSE images by reducing the
technique. effective echo-spacing. The GRAPPA
For the depiction of the surround- technique was much less sensitive to
ing anatomy we used a segmented reconstruction-artifacts than the
3D TrueFISP with spectral fat satura- SENSE technique.

TECHNOLOGY
SIALOGRAPHY
Images of volunteer study (1-4, 11) and of patients (6-10)
Figure 1 ss-TSE sagittal Figure 2 ss-TSE tra. with iPAT. Figure 3 Segmented 3D Figure 4 3D TSE thin MIP.
localizer. TrueFISP.
Figure 5 3D TSE thin MIP.
Figure 6,7,8 Stone in the right main duct; sag-tra ss-TSE, Figure 9,10,11 Sjögren Syndrome; sag ss-TSE, tra TrueFISP,
tra 3D TrueFISP. Normal Parotid.
Parameters used
Sequence TR TE TA TI/FS #SL x Thick FoV Matrix Acq Turbo Factor/ Bandwidth
[ms] [ms] [min] [ms] [mm] [mm 2] Segments [Hz/pixel]
3D TSE 3000 224 3:41 FS 32 x 1.5 160 x 160 251 x 256* 1 65 241
3D TSE iPAT 3000 224 3:41 FS 32 x 1.5 160 x 160 251 x 256 1 65 241
ss-TSE 2800 456 0:03 280 1 x 50 160 x 160 256 x 256 1 256 130
ss-TSE iPAT 2800 456 0:03 280 1 x 50 160 x 160 256 x 256 1 256 130
Seg-3D-TFI 700 2, 29 1:41 FS 24 x 2.5 160 x 160 256 x 256 1 31 570
*using partial fourier in slice and phase encoding direction

TECHNOLOGY
iPAT & PACE
Clinical Results with

T2_tse_rst_3d_pace_ipat Pulse Sequence
Roger J. Demeure, Ph.D. MR CholangioPancreato- the improvement in the signal-to-
Siemens Medical Solutions, graphy (MRCP) noise ratio leads to a hugely superior
Belgium in-plane resolution and to a slice
Techniques: Today, Magnetic Reso- thickness (millimetric range) better
Nicole Nicaise, M.D. nance (MR) imaging is the unique tuned to the anatomical require-
Centre Hospitalier Universitaire modality allowing non-invasive eval- ments of the organ under investiga-
de Charleroi, Belgium uation of the pancreatic ducts, pan- tion.
creatic parenchyma, adjacent tissues, Secondly, compared to the regu-
and vascular network in a single lar 2D image acquisition, the richness
section. In this way, MR CholangioPan- of the 3D data set provided by “tse_rst_
Introduction creatography (MRCP) is useful for 3d_ipat” pulse sequence offers differ-
planning surgery or therapic en- ent procedures for reviewing the
With the arrival of doscopy and follow-up studies after examination of the biliary and pan-
1. the turbo spin echo (tse) with the therapy. creatic system. Indeed, the source
restore (rst) mode Up to now, MRCP examinations images, the “MultiPlanar Reconstruc-
2. the PACE tool and more recently of are realized using strongly T2-weight- tion” (MPR) and the “Maximum Inten-
3. the iPAT option, a 3D high ed RARE and HASTE pulse sequences. sity Projection” (MIP) reconstructions
resolution free breathing pulse Both sequences demonstrate the are both very helpful because they
sequence, “tse_rst_3d_ipat”, will advantages of being very fast and very provide complementary morphologic
very soon be available for the sensitive to fluids. The RARE pulse information. They are better at
routine examinations of millimetric sequence allows the acquisition of a depicting small or complex anomali-
size ducts that lead slow velocity single thick section (20-50 mm) in ties of ducts, i.e. intrahepatic bile
fluids like Wirsung, biliary or any plane with a single short breath ducts stenosis in, for example, “Scle-
salivary ducts. hold (< 3s). Consequently, these rosing Cholangitis”, small intraductal
pulse sequences are very suitable for stones, rupture of the Wirsung and
investigating the Wirsung and the post-surgical bile leakage/stenosis.
biliary ducts. Unfortunately, the RARE Furthermore, in the patients with
pulse sequence suffers from some ascitis, the MIP post processing also
drawbacks. They are 2D pulse enables one to get rid of the intra-
sequences requiring slice thickness peritoneal liquid which is often more
larger than 20 mm (centrimetric difficult when using the classical
range) which might miss the visuali- RARE pulse sequence. For acquisition
zation of small intraductal stones due time reduction and signal-to-noise
to the superposition effect. As work- optimization, it takes benefit of
ing under apnea, they require good multi-channel functionality of our
patient cooperation and strongly system in combination with iPAT.
depend on the reproducibility of the Finally, the last but not the least, this
patient breath holding. Ductal visibil- pulse sequence allows to work in free
ity may be degraded by possible breathing thanks to the PACE (echo
overlap with other fluid-containing navigator) data acquisition synchro-
organs (i.e. stomach and duodenum) nization. As already well known, this
and the presence of ascitis or peri- tool allows the acquisition of images
pancreatic exudates in the field-of- free of motion artifacts in the ab-
view. domen without the need of apnea,
With the arrival soon of the which is very useful in uncooperative
“tse_rst_3d_ipat” all these limitations patients.
of the classically used pulse
sequences are circumvented for
MRCP examinations. This pulse
sequence has all the advantages of
a regular 3D pulse sequence. Firstly,

TECHNOLOGY
iPAT & PACE
Results
Acquisition Parameters: the main

typical acquisition parameters for the
“t2_tse_rst_3d_pace” pulse sequence
are : TR/TEeff = 1630 ms/705 ms, Echo
Train Length (ETL) = 121, Number of
Averages (NA = 1),
Slice Thickness = 1.2 mm, number of
slices in the 3D slab = 60, Fat Sat,
Band Width = 255 Hz/pxl.
Case 1 (Fig. 1):

This 80 year old non-cooperative
woman suffers from pancreatic
cancer. The 3D respiratory triggered
MRCP nicely emphasizes severe distal
stenosis with huge dilation of both
biliary and pancreatic ducts. The
source images that have a thickness
of 1.5 mm allow the exclusion of Figure 1.1 Figure 1.2
a microlithiasis.
Case 2 (Fig. 2):

This 42 year old non-cooperative
patient presents with an alcoholic
type 4 chronic (induced) pancreatitis.
The 3D MRCP nicely depicts the distal
stenosis with upstream dilation of
both biliary and pancreatic ducts.
In addition, a small lithiasis is visible Figure 2.1 Figure 2.2 Figure 2.3
in the t2_tse_rst_3d_pace source
images (Fig. 2.3: arrow).
Case 3 (Fig. 3):

In this 52 year old patient, the MIP
reconstructions nicely depict a distal
stenosis of the right intrahepatic
biliary duct as well as a post cholecys-
tectomy bile leakage (Fig. 3.3: arrow).
Figure 3.1 Figure 3.2 Figure 3.3

TECHNOLOGY
iPAT & PACE
Case 4 (Fig. 4):

These MIP reconstructed images were
acquired in a 58 year old patient with
intraducal papillary mucinous tumor
(Fig. 4.2: arrow). The communication
between the cystic tumor and the
main pancreatic duct is well visual-
ized.
Figure 4.1 Figure 4.2
Case 5 (Fig. 5):

The examination was done in this
non-cooperative 80 year old patient
referred for pre-cholecystectomy
statement. The MIP reconstructed
images depict a low insertion of the
cystic duct (Fig. 5).
Figure 5
Case 6 (Fig. 6):

This 40 year old patient was referred
for pre-cholecystectomy statement.
MPR images (1.5 mm thickness)
show a gallbladder filled with multi-
ple stones (Fig. 6.1 and Fig. 6.2). Into
the thick slice (projections) acquired
with the RARE pulse sequence (Fig.
6.2), we suspected stones in the
common bile duct. That was exclud-
ed thanks to both source and MIP
reconstructions. Figure 6.1 Figure 6.2 Figure 6.3

TECHNOLOGY
iPAT & PACE
Urography
Cholangiography is not the only

possible application of the
“t2_tse_rst_3d_pace” pulse sequence.
It could also be very useful for exami-
nations of the urinary system, espe-
cially in very young children who
are uncooperative and in which the
RARE technique is of bad quality. As
well known, the poor signal-to-noise
ratio produced by the RARE pulse
sequence has a direct effect on the
minimum possible slice thickness and
consequently “t2_tse_rst_3d_pace”
could greatly improve the image
quality for urography.
In addition, as for MRCP, the
analysis of both source images and
the MIP/MPR reconstruction increases Figure 7.1 Figure 7.2
the diagnostic accuracy of congenital
abnormalities, i.e. ectopic ureteral
insertion.
Acquisition Parameters: The
main typical MR parameters utilized
for this kind of examination are:
TR/TEeff = 1910 ms/832 ms,
Echo Train Length (ETL) = 145,
Number of Averages (NA) = 1,
Slice Thickness = 1.5 mm,
Band Width = 260 Hz/pxl.
Results (Fig. 7) :
The MIP images reconstructed
from the “t2_3d_tse_rst_pace” data
set acquired in this non cooperative
5 year old child provide images of
good quality. The multiplanar recon-
structions allow to diagnose the
correct ureteral insertion. Figure 7.3 Figure 7.4
Other Potential Applications References

The current MR data acquisition [ 1 ] Atlas of Cross-Sectional and Projective MR Cholangio-pancreatography.
technique could probably also be L. Van Hoe, D. Vanbeckevoort, W. Van Steenbergen. ISBN 3-540-68831-8,
Springer-Verlag (1999).
used to realize any kind of examina-
[ 2 ] Abdominal and Pelvic MRI. A.L.Baert, K.Sartor, J.E.Youker.
tion where low velocity fluids are ISBN 3-540-67216-8, Springer-Verlag (2000).
present, like salivary gland channels [ 3 ] MR Imaging of the Pancreas : A Pictoral Tour. C.Matos, O.Cappeliez,
(sialography). C.Winant, E.Coppens, J.Devière, T.Metens. 22:2 (2002).

LIFE
UPGRADE
Upgrade MAGNETOM Vision to

MAGNETOM Symphony
Wyncent Wong Changi General Hospital was officially
MR Applications Specialist opened on 28 March 1998 as an
MSc, BAppSc, DCR (R), Dip amalgamation of Toa Payoh Hospital
and Changi Hospital. It is a 800 bed
Siemens Medical Solutions, hospital catering specifically for the
Singapore community in eastern Singapore
with an approximate population of
750.000 and offers a comprehensive
range of medical and paramedical
services. Since the installation of the
MAGNETOM Vision in August 1997,
the system has scanned an estimated
of 15.500 patients before being up-
graded to MAGNETOM Symphony
Maestro Class on March 2004, mak-
ing it the first of such upgrades in the
region.
With the managed upgrade to
MAGNETOM Symphony, all but the
magnet was replaced. The gradient
Figure 1 Changi General Hospital. strength was increased to 30 mT/m
with the true slew rate of 125 T/m/s.
Speed is especially significant since
the system provides services such as
cardiac and abdominal MR in addi-
tion to the routine neuro and muscu-
loskeletal MR. Free breathing exami-
nations become a clinical reality with
PACE (Prospective Acquisition Cor-
rEction). PACE is part of Inline Tech-
nology, a MAGNETOM Family feature
that stands for processing instead of
post-processing. Inline Technology
processes and reconstructs image
data on-the-fly such as motion
correction. With the Maestro User
Interface performing cardiac MR has Figure 3 Whole spine sagittal T1
never been easier. with Integrated Panoramic Array.
Figure 2 MAGNETOM Symphony

Maestro Class, a MAGNETOM Vision
upgrade.

LIFE
UPGRADE
Figure 4 Consultant Radiologist, Dr. Andrew Tan.
With Maestro Class, iPAT, the

integrated Parallel Acquisition Tech- Figure 7 CE-MRA Carotids.
nique is standard and there is no
need to purchase additional coils
since most of the standard coils are
already iPAT compatible.
Dr. Tan, who has a keen interest in
body MR, was particularly impressed
with the speed of the new system.
“With the panoramic table option,
performing contrast enhanced MRA Figure 5 Turboflash T1 with water Figure 8 TSE T2 breath hold and
of the peripheral vessels has been so excitation and PACE free breathing. TrueFISP Cine Retrogated.
much easier. With inline subtraction,
it really saves us so much time. I am
also very impressed with the restore
pulse sequence which was previously
not available on the MAGNETOM
Vision. It produces very nice T2-
weighted spine images with much
fewer artifacts.” Senior Radiographer
in charge – Mr. Salem Koh – agreed
that it was definitely the right deci-
sion to upgrade the system and that
he would strongly recommend such Figure 6 Flash T1 out of phase
an upgrade. With the MAGNETOM
Symphony system, he noticed an
increase of 20 % in the daily patient grams for coils and application pack- Figure 9 CSI SE TE 30.
throughput.* ages, the ongoing training opportu-
But even without a major system nities, and the syngo Evolve program™,
upgrade to a new product generation, are all building blocks of Life to help
the Siemens’ customer care program your system match up to the latest
– Life – guarantees that the invest- standards and enable you to keep up-
ment in a MAGNETOM system will to-date with the all the applications
never become obsolete. The trial pro- for the latest techniques in MR. * Results may vary. Data on file.

LIFE
SINGAPORE
4th MAGNETOM World Summit

September 2005, Singapore
Dear MAGNETOM User,
Welcome to Singapore!
The MAGNETOM World community user meetings provide an excellent

opportunity for you to establish personal contacts and exchange valuable
information with other users from all over the world. Such a platform
will undoubtedly help lay a path for trend-setting developments in MR.
Following our successful meetings in Nice, Miami and our traditional

Bavarian event in Rottach-Egern this year, the next MAGNETOM World
Summit will take place in Singapore.
Fountain of Wealth –
The largest fountain in
For the first time, our Singapore World Summit will integrate the Cardiac
the world.
MR Ambassador Meeting, the Ultra High-field Meeting and the Low field
Meeting. Such a comprehensive agenda and the variety of customers from
different backgrounds will make your participation even more worthwhile.
Singapore is truly unique: a dynamic city rich in contrast and color, and
a bridge for centuries, it continues to embrace tradition and modernity.
We will ensure that our MAGNETOM World members experience another
unforgettable event full of stimulation and relaxation in equal measure.
For further information, please contact your Sales Representative or watch

out for upcoming news on our MAGNETOM World website at
www.siemens.com/magnetom-world.
Best regards,
MAGNETOM World Summit Team

LIFE
SINGAPORE
Skyline of Singapore’s Central

Business District.
Merlion – Half lion, half fish is a national icon.
Vanda Miss Joaquim –

Images courtesy of the Singapore Tourism Board and The Fullerton Singapore. Singapore’s national flower.

Contact Addresses
In the USA
Siemens Medical Solutions USA, Inc.
51 Valley Stream Parkway
Malvern, PA 19355
The information in this document contains general Telephone: +1 888-826-9702
descriptions of the technical options available, which
Telephone: +1 610-448-4500
do not always have to be present in individual cases.
Telefax: +1 610-448-2254
The required features should therefore be specified in
each individual case at the time of closing the contract.
In Japan
Siemens reserves the right to modify the design and Siemens-Asahi
specifications contained herein without prior notice. Medical Technologies Ltd.
Please contact your local Siemens sales representative
for the most current information.
Takanawa Park Tower 14F
20-14, Higashi-Gotanda 3-chome
Original images always lose a certain amount of detail
when reproduced.
Shinagawa-ku
Tokyo 141-8644
This brochure refers to both standard and optional
features. Availability and packaging of options varies by
Telephone: +81 3 5423 8411
country and is subject to change without notice.
Some of the features described are not available for In Asia
commercial distribution in the US.
Siemens Medical Solutions
Asia Pacific Headquarters
The Siemens Center
Siemens AG 60 MacPherson Road
Wittelsbacherplatz 2 Singapore 348615
D-80333 Muenchen Telephone: +65 6490-6000
Germany Telefax: +65 6490-6001
Headquarters In Germany
Siemens AG, Medical Solutions Siemens AG, Medical Solutions
Henkestr. 127, D-91052 Erlangen Magnetic Resonance
Germany © 2004 Siemens Medical Solutions
Henkestr. 127, D-91052 Erlangen
Order No. A91100-M2220-F691-8-7600
Telephone: +49 9131 84-0 Germany Printed in Germany
www.siemens.com/medical Telephone: +49 9131 84-0 GP 00000 WS 120420.

2004 2005 Magnetom Flash 2 2

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MAGNETOM

Issue no. 2 · 2004

Upgrade MAGNETOM Vision

2 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

52 MRI Procedures and Transdermal Medication Patches

54 Fast and Ultrafast MR-Sialography

58 Clinical Results with T2_tse_rst_3d_pace_ipat Pulse Sequence

MAGNETOM FLASH 2/2004 3

Farewell to all MAGNETOM

4 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

We thank Mr. Lowrence Tallentire for this editorial help.

MAGNETOM FLASH 2/2004 5

The World’s First Open Bore, High-Field

6 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

At Mayo Clinic creativity in using

MAGNETOM FLASH 2/2004 7

Carotid MRA with coverage from

• Inline Technology enables real-

The second MAGNETOM Espree

8 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

MAGNETOM FLASH 2/2004 9

10 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

The MAGNETOM C! was introduced to the customers in

MAGNETOM C! appearing from a cloud of mist and lights

MAGNETOM FLASH 2/2004 11

3D MIP, FLASH 2D, 512 matrix,

TIRM Dark Fluid, 512 matrix, 239 mm FoV, SL 5.0 mm.

12 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

MAGNETOM FLASH 2/2004 13

TSE Restore, 512 matrix, 300 mm FLASH 2D we, 256 matrix,

3D MRCP with 2D PACE multi direc- Cine FLASH 2D with tagging,

3D MIP, FLASH 2D, Hui Yang No. 1

14 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

FLASH 2D, 512 matrix, Triple contrast TSE, 512 matrix,

MAGNETOM FLASH 2/2004 15

Case Report: MRCP and MR of the Liver

16 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

FLASH 3D FLASH 3D FLASH 3D

FLASH 3D FLASH 3D T2_TSE_fs

FLASH 2D_fs FLASH 2D_fs FLASH 2D_fs

MAGNETOM FLASH 2/2004 17

MRA arterial phase. MRA portal venous phase.

18 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

TrueFISP (coronal and sagittal):

T2w TSE (sagittal):

The safety of imaging (fetuses, infants)

MAGNETOM FLASH 2/2004 19

The safety of imaging (fetuses, infants)

20 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

TrueFISP TrueFISP TrueFISP

The safety of imaging (fetuses, infants)

MAGNETOM FLASH 2/2004 21

Orientation TI TR TE BW FA FoV Matrix No Slice th. Gap iPAT TA

22 www.siemens.com/magnetom-world MAGNETOM FLASH 2/2004

VIBE 3D VIBE 3D VIBE 3D

VIBE 3D VIBE 3D VIBE 3D

MAGNETOM FLASH 2/2004 23

FLASH 2D FLASH 2D VIBE 3D

VIBE 3D VIBE 3D VIBE 3D

VIBE 3D VIBE 3D FLASH 2D

MRA MIP view MRA MIP view

MRA MIP view MRA MIP view